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The article focuses on a 15-year-old male with fever, rash, and abnormal laboratory findings, ultimately diagnosed with a viral infection. Topics include his medication history with minocycline, the broad differential diagnosis including conditions like toxic shock syndrome and Stevens-Johnson syndrome, and the positive respiratory viral panel for human metapneumovirus.

Background: Multiparametric MRI markers of liver health corrected T1 (cT1) and proton density fat fraction (PDFF) have shown utility in the management of various chronic liver diseases. We assessed the normal population reference range of both cT1 and PDFF in healthy child and adult volunteers without any known liver disease. Methods: A retrospective multi-centre pooled analysis of 102 child and young adult (9.1 years (6–18)) volunteers from three centres: Children's Memorial Health Institute (N = 21), University Hospital Southampton (N = 28) and Hospital Infantil de Mexico (N = 53). Sex and ethnic differences were investigated for both cT1 and PDFF. Age effects were investigated with comparison to a pooled adult cohort from the UK Biobank (N = 500) and CoverScan (N = 71), covering an age range of 21 to 81 years. Results: cT1 values were normally distributed with a median of 748 ms (IQR: 725–768 ms; 2.5–97.5 percentiles: 683–820 ms). PDFF values followed a normal distribution with a median of 1.7% (IQR: 1.3–1.9%; 2.5–97.5 percentiles: 1–4.4%). There were no significant age and sex differences in cT1 and PDFF between children and young adults. No differences in cT1 and PDFF were found between ethnicities. Age comparisons showed statistically significant, but clinically negligible, cT1 (748 ms vs. 732 ms) and PDFF (2.4% vs. 1.9%) differences between paediatric and adult groups, respectively. Conclusions: Median healthy cT1 and PDFF reference ranges in children and young adults fall within the reported limits for normal of 800 ms and 5%, respectively. [ABSTRACT FROM AUTHOR]

Background and Aim: The histological diagnosis of autoimmune hepatitis (AIH) is challenging. A new consensus recommendation was provided by the International AIH Pathology Group to address the problems in the histological diagnosis. The purpose of this study is to compare the 2008 ‘simplified’ criteria for AIH with the ‘consensus recommendation’ of 2022 in terms of diagnostic sensitivity. Materials and Methods: A retrospective analysis was conducted on pathological specimens of patients diagnosed with Autoimmune Hepatitis (AIH) between 2010 and 2022. Out of 188 patients enlisted, 88 were selected based on exclusion criteria. The specimens were examined by two experienced hepatopathologists and a resident pathologist. All specimens were analyzed using both the “simplified” criteria and the new consensus recommendations. Results: Out of a total of 78 patients, the 2022 consensus recommendations raised the diagnostic category of 16 patients (20.5%) to a higher level. Six patients who were previously diagnosed as “atypical” were now considered “possible AIH”, while 10 patients with a “compatible” diagnosis were elevated to “likely AIH” category. No patients were found to fall into a lower diagnostic category according to the new recommendations. A significant difference in diagnostic sensitivity was observed between the 2008 criteria and the 2022 consensus report (p<0.001). Conclusion: The 2022 consensus recommendation may be more sensitive in the diagnosis of AIH in comparison to the 2008 ‘simplified’ histological criteria. More studies are needed both for the validation of the sensitivity of the new consensus recommendation and for the determination of the specificity. [ABSTRACT FROM AUTHOR]

Making a diagnosis of alcoholic liver disease is not always easy. There are problems in obtaining an accurate and reliable history of alcohol consumption. Laboratory findings and hepatic imaging studies are neither sensitive or specific, and newer test are being considered. Recently, a patient was admitted with possible alcoholic hepatitis. The first-year resident who admitted the patient mistakenly ordered a blood test for serum IgE. The result was a markedly elevated −6440 IU/mL. There was no evidence of parasitic infections, atopy or autoimmune disease nor was there any eosinophilia. A literature search showed that elevated IgE levels are associated with alcohol abuse. This association has been forgotten and does not appear in standard reference sources such as UptoDate or Harrison's Principles of Internal Medicine. This judicious use of examining serum IgE levels may aid in the diagnosis of alcoholic hepatitis. [ABSTRACT FROM AUTHOR]

Objective • To investigate the diagnostic significance of the combination of alpha-fetoprotein (AFP), serum abnormal prothrombin (PIVKA-II), and α-L-Fucosidase (AFU) in hepatocellular carcinoma (LC). Methods • A total of 580 cases of chronic hepatitis B patients were collected, including 124 cases of hepatitis B-related liver cancer patients treated in our hospital from March 2021 to December 2022, 325 cases of simple chronic hepatitis B patients, and 189 cases of hepatitis B cirrhosis patients from our hospital in the same period. We measured serum levels of AFP, PIVKA-II, and AFU using ELISA. Statistical analysis was performed using SPSS software, employing t tests, ANOVA. ROC curves were used to assess the effectiveness of the three markers alone and in combination for screening hepatitis B-associated liver cancer from patients with chronic hepatitis B. Results • The serum levels of AFP and PIVKA-II were significantly higher in the hepatitis B liver cancer group compared to the cirrhotic hepatitis B group and the chronic hepatitis B group, with statistically significant differences (P < .05). The AFU level in the hepatocellular carcinoma group was also significantly higher than that in the chronic hepatitis B group (P < .05). When individually tested, the AUC of PIVKA-II was the largest, followed by AFP, and AFU had the smallest AUC (P < .05). When combined, the AUC was the greatest, reaching XX, outperforming individual markers alone or their combinations. This suggests that combining AFP, AFU, and PIVKA offers improved sensitivity (86.5%) and specificity (97.8%) for liver cancer diagnosis. These findings indicate the potential clinical relevance of utilizing these biomarkers together for accurate detection and monitoring of liver cancer. Conclusion • The combination of AFP, AFU, and PIVKAII demonstrates improved diagnostic accuracy in early detection of hepatitis B-related hepatocellular carcinoma, particularly in patients with chronic hepatitis B complicated by cirrhosis. These findings have significant clinical implications, as early diagnosis enables timely intervention and treatment, potentially improving patient outcomes and guiding appropriate therapeutic strategies for affected individuals. [ABSTRACT FROM AUTHOR]

Background: Hospitalization and mortality in patients with alcohol‐associated hepatitis (AH), a severe form of liver disease, continue to increase over time. Given the severity of the illness, most hospitalized patients with AH are admitted from the emergency department (ED). However, there are no data on ED utilization by patients with AH. Thus, the Nationwide Emergency Department Sample (NEDS) dataset was analyzed to determine the ED utilization for AH. Methods: Temporal trends (2016–2019) and outcomes of ED visits for AH were determined. Primary or secondary AH diagnoses were based on coding priority. Numbers of patients evaluated in the ED, severity of disease, complications of liver disease, and discharge disposition were analyzed. Crude and adjusted rates were examined, and temporal trends evaluated using logistic regression with orthogonal polynomial contrasts for each year. Results: There were 466,014,370 ED visits during 2016–2019, of which 448,984 (0.096%) were for AH, 85.0% of which required hospitalization. The rate of visits for AH (primary and secondary) between 2016 and 2019 increased from 85 to 106.8/100,000 ED visits. The rate of secondary AH increased more than the rate of primary AH (from 68.6 to 86.5 vs. from 16.4 to 20.3/100,000 ED visits). Patients aged 45–64 years had the highest rate of ED visits for AH, which decreased during the study period, while the rate of ED visits for AH increased in those aged 25–44 years (from 38.5% to 42.9%). The severity of disease (ascites, hepatic encephalopathy, and acute kidney injury) also increased over time. Medicaid and private insurance were the most common payors for patients seeking care in the ED for AH. Conclusions: Temporal trends show an overall increase in ED utilization rates for AH, more patients requiring hospitalization, and an increase in the proportion of younger patients presenting to the ED with AH. [ABSTRACT FROM AUTHOR]

Wilson's disease (WD) with acute onset poses a diagnostic challenge because it is clinically indistinguishable from other acute liver diseases. In addition, serum ceruloplasmin and urinary copper excretion, the first-line diagnostic tools for WD, can show false positive results in the case of acute liver failure, and the diagnostic role of genetic analysis is limited by the time required to perform it. In the case of fulminant onset, there is a clear indication of liver transplantation. "New Wilson Index" is frequently used to discriminate between patients who need liver transplantation versus those who can be successfully managed by medical treatment, but its reliability remains controversial. Timely referral of patients with acute liver failure due to WD may be a key factor in improving patient survival. Although liver transplant very often represents the only chance for such patients, maximum effort should be made to promote survival with a native liver. The management of these aspects of WD is still a matter of debate and will be the subject of this review. [ABSTRACT FROM AUTHOR]

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In late 2021, the CDC was alerted to a cluster of children with hepatitis of unknown etiology at a US hospital. Similar reports began to emerge out of Europe. This article discusses the systematic investigation into these cases. [ABSTRACT FROM AUTHOR]

Hepatitis is an infectious disease typified by inflammation in internal organ tissues, and it is caused by infection or inflammation of the liver. Hepatitis is often feared as a fatal illness, especially in developing countries, mostly due to contaminated water, poor sanitation, and risky blood transfusion practices. Although viruses are typically blamed, other potential causes of this kind of liver infection include autoimmune disorders, toxins, medicines, opioids, and alcohol. Viral hepatitis may be diagnosed using a variety of methods, including a physical exam, liver surgery (biopsy), imaging investigations like an ultrasound or CT scan, blood tests, a viral serology panel, a DNA test, and viral antibody testing. Our study proposes a new decision-support system for hepatitis diagnosis based on spherical q-linear Diophantine fuzzy sets (Sq-LDFS). Sq-LDFS form the generalized structure of all existing notions of fuzzy sets. Furthermore, a list of novel Einstein aggregation operators is developed under Sq-LDF information. Also, an improved VIKOR method is presented to address the uncertainty in analyzing the viral hepatitis categories demonstration. Interesting and useful properties of the proposed operators are given. The core of this research is the proposed algorithm based on the proposed Einstein aggregation operators and improved VIKOR approach to address uncertain information in decision support problems. Finally, a hepatitis diagnosis case study is examined to show how the suggested approach works in practice. Additionally, a comparison is provided to demonstrate the superiority and efficacy of the suggested decision technique.

Pregnant women are a vulnerable group to infection with the Hepatitis B virus. Based on World Health Organization data in 2019, an estimated 296 million people are infected with chronic hepatitis B with 1.5 million new infections per year. In 2019 in Indonesia, the number of pregnant women tested for hepatitis B using the HBsAg rapid diagnostic test (RDT) was 2,540,158 people (48.25%) of the target pregnant women. the purpose of this study was to determine the relationships between the roles of midwives, mothers' knowledge, husbands' support, and compliance of pregnant women in carrying out HBsAg examinations at PMB Wagi Koja, North Jakarta in 2023. This research method uses an observational survey and is a type of quantitative research, with a cross-sectional study design. The number of samples in this study was 32 people, with a sampling technique that is total side. The results in this study are P value <α, where Ha is accepted and H0 is rejected, so it can be concluded that there is a relationship between the role of the midwife (P value = 0.036 and OR=6.500), knowledge (P value=0.015 and OR=8.750) and support husband (P value=0.029 and OR=7.333) with compliance of pregnant women in carrying out HBsAg examinations at PMB Wagi Koja North Jakarta in 2023. This study concludes that there is a relationship between the roles of midwives, husband's knowledge, and support with compliance of pregnant women in carrying out HBsAg examinations at PMB Wagi Koja North Jakarta in 2023. it is hopedthat PMB Koja will provide counseling and education about the important of prenatal checkups, especially HBsAg checks, and advise husbands and families to provide emotional and instrumental supportand facilitate the needs of mothers during checkups. [ABSTRACT FROM AUTHOR]

Background: Ischemic hepatitis (commonly referred to as shock liver and hypoxic hepatitis) is an uncommon clinical condition associated with massive but transient elevation of liver enzymes up to more than 20 times the standard limit; without evidence of other causes of acute hepatitis such as viral, alcoholic, metabolic, and toxin-induced hepatitis. Clinically, it presents as an acute liver failure caused by decreased hepatic perfusion and oxygen delivery. It is often encountered in critically ill patients in intensive care units and can rarely be triggered by pericardial tamponade. Case presentation: On hemodialysis, a 33-year-old end-stage renal disease male patient with hypertension and cardiomegaly presented with right upper quadrant pain. Examination revealed elevated jugular venous pressure, displaced apical beat, tender right upper quadrant and epigastric areas, and enlarged liver with a round border and soft surface. Electrocardiography revealed P mitral and electrical alternans but no ischemic changes. Chest radiography showed an increased cardiothoracic ratio and flask-shaped heart. Extensive laboratory investigations showed elevated levels of aspartate aminotransferase (5000 U/L) and alanine aminotransferase (7000 U/L). Ultrasound showed passive congestion of the liver. Pericardial effusion was confirmed by echocardiography, and the diagnosis of cardiac tamponade was established. Pericardiocentesis was done, and 1200 ml of bloody fluid was aspirated. After pericardiocentesis, the patient demonstrated dramatic improvement. Conclusions: Ischemic hepatitis is an uncommon entity associated with a significant mortality rate, mainly when it develops on top of decreased cardiac output. Therefore, physicians must be familiar with the broad differential diagnosis for liver disease signs and symptoms and should always consider the possibility of ischemic hepatitis in such cases. [ABSTRACT FROM AUTHOR]

Aim: Differentiating alcoholic hepatitis (AH) from acute decompensation of alcoholic cirrhosis (DC) is challenging, as the presentation and biochemistry are similar. We aimed to identify potential metabolomic biomarkers to differentiate between AH and DC, and to predict short-term mortality. Methods: We included consecutive biopsy proven AH and DC patients, which were managed according to current guidelines and followed up until the end of the study. Untargeted metabolomics was assessed in all patients at baseline. Specific analyses were successively performed to identify potential biomarkers, which were further semi-quantitatively analysed against relevant clinical endpoints. Results: Thirty-four patients with AH and 37 with DC were included. UHPLC-MS analysis identified 83 molecules potentially differentiating between AH and DC. C16-Sphinganine-1P (S1P) was the most increased, whereas Prostaglandin E2 (PGE2) was the most decreased. The PGE2/S1P ratio < 1.03 excellently discriminates between AH and DC: AUC 0.965 (p < 0.001), Se 90%, Sp 100%, PPV 0.91, NPV 1, and diagnostic accuracy 95%. This ratio is not influenced by the presence of infection (AUC 0.967 vs. 0.962), correlates with the Lille score at 7 days (r  = −0.60; P  = 0.022) and tends to be lower in corticosteroid non-responders as compared with patients who responded [0.85(±0.02) vs. 0.89(±0.05), P  = 0.069]. Additionally, decreased ursodeoxycholic acid levels are correlated with MELD and Maddrey scores and predict mortality with a 77.27% accuracy (NPV = 100%). Conclusion: This study suggests the PGE2 (decreased)/S1P (increased) ratio as a biomarker to differentiate AH from DC. The study also finds that low levels of ursodeoxycholic acid could predict increased mortality in AH. [ABSTRACT FROM AUTHOR]

Background and Objectives Intravenous immunoglobulin (IVIG) is a biological product containing a mixture of IgGs which is needed to protect special patients against various microbial pathogens. Due to worldwide decrease in the prevalence of viral hepatitis, the protective effect of immunoglobulins in treatment needs to be re-examined. For this reason the presence of, antiHAV, anti-HBs, Anti HBc, anti-HGV, anti-HDV and anti-HEV antibodies in the IVIG products of Iranian plasma have been investigated. Materials and Methods In this randomized descriptive cross-sectional study, the presence or absence of antibodies against hepatitis A, hepatitis E, hepatitis D, hepatitis G, antibodies against hepatitis B surface antigen and hepatitis B core antigen in 38 different lots of IVIG products from the Iranian recovered and source plasma was determined by ELISA method and anti-HAV and anti-HBs antibodies were titrated. Results Total anti-HAV in IVIGs was 38304 ± 17735 mIU/mL and this titer was significantly higher in IVIGs from recovered plasma compared with source plasma. Total anti-HBs titer in IVIGs was equal to 2487 ± 965 mIU/mL, and no significant difference was observed between the two types of recovered and source plasma. Anti-HBc, Anti-HEV and Anti-HGV were detected in all products, while no anti-HDV was found. Conclusions Despite the worldwide decrease in the prevalence of viral hepatitis and reports of a decrease in anti-HAV and anti-HBs titers in IVIG products, IVIG products prepared from Iranian plasma have acceptable anti-HAV and anti-HBs titers according to the European Pharmacopeia and are suitable for replacement therapy. [ABSTRACT FROM AUTHOR]

Context.--Cytomegalovirus (CMV) hepatitis in allograft livers is an important infectious complication, with histology that historically has been described to overlap with that of acute cellular rejection (ACR), a diagnosis that compels a different treatment regimen. Objective.--To update the clinicopathologic features of CMV hepatitis and explore its clinical and histologic relationship with ACR. Design.--A retrospective analysis of 26 patients with a diagnosis of CMV hepatitis across 4 institutions was performed, including clinical, histologic, and immunohistochemical features. Results.--Patients were predominantly CMV donor positive/recipient negative (D+/R-; n = 9 of 15) and received a diagnosis of CMV hepatitis at a mean age of 52 years (SD, 17 years), at a mean interval of 184 days (SD, 165 days) from transplantation. Mean CMV viral load at diagnosis was 241 000 IU/mL (SD, 516 000 IU/mL), and liver biochemical enzymes were elevated (mean alanine aminotransferase, 212 U/L [SD, 180 U/L]; mean aspartate aminotransferase, 188 U/L [SD, 151 U/L]; mean alkaline phosphatase, 222 U/L [SD, 153 U/L]). Ten cases did not show histologic features of ACR, and 16 cases demonstrated features of ACR (including marked bile duct injury and endotheliitis). Viral cytopathic change was found in all cases. All patients were treated with a combination of antiviral therapy and CMV intravenous immunoglobulin, with near resolution of biochemical enzymes in all patients with undetectable serum CMV viral titers. Conclusions.--CMV hepatitis and ACR are complex processes with interlinking mechanisms that are important to distinguish. A subset of transplantation patients with CMV hepatitis show histologic changes that mimic ACR but were treated successfully with antiviral therapy alone. [ABSTRACT FROM AUTHOR]

Hepatitis is an infectious disease typified by inflammation in internal organ tissues, and it is caused by infection or inflammation of the liver. Hepatitis is often feared as a fatal illness, especially in developing countries, mostly due to contaminated water, poor sanitation, and risky blood transfusion practices. Although viruses are typically blamed, other potential causes of this kind of liver infection include autoimmune disorders, toxins, medicines, opioids, and alcohol. Viral hepatitis may be diagnosed using a variety of methods, including a physical exam, liver surgery (biopsy), imaging investigations like an ultrasound or CT scan, blood tests, a viral serology panel, a DNA test, and viral antibody testing. Our study proposes a new decision-support system for hepatitis diagnosis based on spherical q-linear Diophantine fuzzy sets (Sq-LDFS). Sq-LDFS form the generalized structure of all existing notions of fuzzy sets. Furthermore, a list of novel Einstein aggregation operators is developed under Sq-LDF information. Also, an improved VIKOR method is presented to address the uncertainty in analyzing the viral hepatitis categories demonstration. Interesting and useful properties of the proposed operators are given. The core of this research is the proposed algorithm based on the proposed Einstein aggregation operators and improved VIKOR approach to address uncertain information in decision support problems. Finally, a hepatitis diagnosis case study is examined to show how the suggested approach works in practice. Additionally, a comparison is provided to demonstrate the superiority and efficacy of the suggested decision technique. [ABSTRACT FROM AUTHOR]

This is a 54-year-old woman from Germany of central European origin who developed an acute hepatitis while orally taking Ayurvedic herbal remedies, among those was the medicinal herb Tinospora cordifolia. She took the plant powders from July 1, 2021, to October 1, 2021, with the intention of relieving the symptoms of her subjectively irritated gastrointestinal tract. The patient's main symptoms of acute hepatitis were progressively increasing general fatigue, nausea, and exhaustion. During an inpatient hospital admission from November 4, 2021, to November 9, 2021, she was under clinical observation, but no specific therapeutic measures were deemed necessary; however, blood chemistry showed an acute toxic hepatitis. There was no clinical or laboratory evidence of acute liver failure. Aminotransferase values decreased to normal values on December 14, 2021, by themselves. This case report contributes to the ongoing discussion about the potential risks of triggering an acute hepatitis due to the intake of herbal remedies from the Tinospora genus in rare cases, differentiating other involved risk factors. The case also shows that causality assignments are not trivial in the context of multivariate clinical scenarios. In the case of known hepatic metabolism-associated risk factors, T. cordifolia should be used with more caution based on available case reports. At the same time, no hasty and exaggerated prejudgments should be made about this medicinal herb, which has been very successfully used in traditional South Asian systems of medicine for many centuries. [ABSTRACT FROM AUTHOR]

An 82‐year‐old man was treated with ipilimumab and nivolumab for malignant pleural mesothelioma. Although he was previously treated with prednisolone (1 mg/kg/day) for immune‐related adverse event (irAE) hepatitis by a previous doctor, he still had worsening liver function and was transferred to our hospital. Blood tests and imaging findings were negative for autoimmune and infectious hepatitis, and liver biopsy results were consistent with irAE hepatitis. Steroid pulse therapy improved liver function, but tapering to prednisolone (1 mg/kg/day) again worsened his liver function. Concomitant use of mycophenolate mofetil was initiated, but no improvement in liver function was observed, therefore azathioprine, a thiopurine immunosuppressant, was administered in combination with steroids. During the course of treatment, hepatic dysfunction due to azathioprine was suspected, and the concomitant use of mercaptopurine and prednisolone was started. Afterward, the liver function improved, and the prednisolone dose was gradually reduced to 10 mg/day. This is a rare case in which a thiopurine‐based immunosuppressant was effective against irAE hepatitis, therefore thiopurine‐based immunosuppressants may be effective against steroid‐refractory hepatitis. [ABSTRACT FROM AUTHOR]

Reports of acute hepatitis with unknown origin in children have been published worldwide since April 2022. Due to the unfamiliar nature of the disease and the alarming trend of increasing reports worldwide, health workers must become aware of its diagnosis and treatment. Accordingly, the committee for developing guidelines for the Department of Pediatrics, Tehran University of Medical Sciences, prepared a clinical guideline for more efficient management of these patients. Due to the limited information about this disease, it has been tried to categorize and specify the required diagnostic and treatment measures based on the latest published data. Herein we express this algorithmic approach and diagnostic and therapeutic guidelines for acute hepatitis with unknown origin in children. [ABSTRACT FROM AUTHOR]

Aim of the study: To assess the expression of selected miRNAs as predictive factors of hepatological complications in Epstein-Barr virus (EBV)-infected children. Material and methods: This study included 68 children infected with EBV aged 1 to 18 years hospitalised between 01.12.2018 and 31.12.2020 in the Department of Paediatrics, Infectious Diseases and Hepatology. The expression of 5 miRNAs (miR-122-5p, miR-21-3p, miR-34a-5p, miR-26b-5p, miR-199a-5p) was analysed by real-time PCR using the TaqMan Fast Advanced Master Mix kit. Results: In the group of EBV-infected children, statistically significantly higher expression for miR-21-3p, miR-122-5p, miR-26b-5p and miR-34a-5p was confirmed. In a group of 54 children diagnosed with hepatitis, along with an increase in alanine aminotransferase (ALT) and γ-glutamyl transpeptidase (GGTP) activity, an increase in expression of miR-21-3p, miR-122-5p, miR-26b-5p, miR-34a-5p and miR-199a-5p was observed. Conclusions: Increased expression of miR-21-3p, miR-122-5p, miR-26b-5p, miR-34a-5p and miR-199a-5p in EBV-infected children appears to be a risk factor for hepatological complications progressing to biliary pole defects. [ABSTRACT FROM AUTHOR]

Objective: Due to the common transmission routes, hepatitis B virus (HBV) and hepatitis C virus (HCV) coinfections are common in people living with human immunodeficiency virus (PLWH). We planned to investigate the frequency of HBV and HCV coinfection in PLWH. Materials and Methods: In this single-center, retrospective, and observational study, 277 PLWH were evaluated between January 2016 and August 2022 in a Training and Research Hospital, in Türkiye. Results: The median age of patients was 42±13 years, and 84.8% were male. Nine patients (3.2%) were found to be positive for HBsAg, 11 (3.9%) were positive for isolated anti-HbcIgG, 65 (23.5%) were both positive for anti-HBcIgG and anti-HBs, and 102 (36.8%) were immunized with the hepatitis B vaccine (positive for Anti-HBs). Four of the HBsAg-positive patients were diagnosed with acute hepatitis B clinic during the emergency admission. HBV DNA levels were undetectable in admission and follow-up among the patients with isolated anti-HBcIgG positivity. Three patients were anti-HCV-positive and HCV RNA levels were negative in two patients. Conclusion: HIV infection accelerates the progression of hepatitis B/C-related liver disease due to immunosuppression. It is important to detect and follow-up on HBV/HCV serologic markers in these patients' groups. [ABSTRACT FROM AUTHOR]

The author talks about identifying and managing hepatitis delta virus (HDV). She discusses the reason that HDV is underaddressed and under-identified, recommendation of the American Association for the Study of Liver Diseases (AASLD) guidance for risk-based screening and details risk factors that should prompt providers to screen for HDV, and treatment options for HDV.

Introduction: The aim of the study was to assess the relationship between the concentration of pro-inflammatory cytokines such as interleukin 6 (IL-6), tumour necrosis factor α (TNF-α), soluble intercellular adhesion molecule 1 (s-ICAM-1), and Epstein-Barr virus (EBV) DNA viraemia in children with infectious mononucleosis and hepatitis. Material and methods: The Epstein-Barr virus DNA load in the plasma of 36 immunocompetent patients aged 2.5–18 years with a symptomatic (sore throat, cervical lymph node enlargement, fatigue, and fever), antibody-confirmed EBV primary infection was assessed using a quantitative real-time polymerase chain reaction assay. The concentration of IL-6, s-ICAM-1, and TNF-α in serum was determined using enzyme-linked immunosorbent assay tests. Results: In a group of patients with infectious mononucleosis caused by EBV and viraemia > 3.5 log10 copies/ ml, shorter duration of symptoms, and higher serum levels of s-ICAM-1 and C-reactive protein (CRP) were confirmed. In group of children with EBV hepatitis and CRP > 5 mg/l, levels of s-ICAM-1, γ-glutamyl transpeptidase activity, count of total white blood cells and lymphocytes, and EBV DNA load were significantly higher than in patients with CRP < 5 mg/l. Among patients with EBV hepatitis the increase of s-ICAM-1 concentration correlated with the increase of IL-6 and TNF-α serum levels. Conclusions: The results suggest a higher risk of cholestatic complications in children with elevated CRP level. They indicate that EBV DNA viraemia in conjunction with an s-ICAM-1, IL-6, and TNF-α assessment may be helpful in selecting patients requiring hospitalization [ABSTRACT FROM AUTHOR]

The most common causes of acute hepatitis in children are hepatitis A and autoimmune hepatitis. Hepatitis in the course of Wilson’s disease is sporadically registered in adolescents. An increase of activity of aminotransferases both in the course of multisystem inflammatory syndrome in children (MIS-C) and in the course of COVID-19 has been observed. Hepatitis is common in children with MIS-C and is associated with a more severe presentation and persistent elevation of liver function tests. To date, no cases of acute hepatitis in children due to COVID-19 have been reported. We present 2 cases of acute hepatitis in children where the only cause seems to be a previous asymptomatic SARS-CoV-2 infection. [ABSTRACT FROM AUTHOR]

A novel laccase mimic enzyme Cu–Mn with excellent photothermal properties was firstly prepared via a combination of hydrothermal and in situ synthesis. Cu–Mn nanozymes could catalyze the typical laccase substrate 2,4-dichlorophenol (2,4-DP) to generate the red quinone imine. Further, loading the MnO 2 nanosheets with photothermal properties, Cu–Mn nanozymes possessed not only excellent laccase catalytic activity, but also high photothermal conversion efficiency. The presence of glutathione S-transferase (GST) recovered the glutathione (GSH)-induced weakness of the laccase activity and photothermal properties of Cu–Mn. Hence, a GST enzyme-regulated dual-mode sensing strategy was established based on Cu–Mn nanozymes. The detection limits of GST monitoring based on colorimetric and photothermal methods were 0.092 and 0.087 U/L with response times of 20 min and 8 min, respectively. Furthermore, the proposed method enabled the measuring of GST levels in human serum and was successfully employed in the primary evaluation of hepatitis patients. Another attraction, the impressive photothermal behavior also endowed the Cu–Mn nanozymes with promising antimicrobial properties, which exhibited significant antimicrobial effects against Escherichia coli (E.coli) and Staphylococcus aureus (S.aureus). Unsurprisingly, multifunctional Cu–Mn nanozymes certainly explore new paths in biochemical analysis and antimicrobial applications. [Display omitted] [ABSTRACT FROM AUTHOR]

Objective: Fitz-Hugh-Curtis Syndrome (FHCS) is an inflammation of the liver capsule as a complication of pelvic inflammatory disease (PID) in sexually active women, mostly associated with Chlamydia trachomatis (C. trachomatis) and Neisseria gonorrhoeae. Classically presenting as sharp right upper quadrant pain, usually accompanied salpingitis and ascites. With nonspecific clinical presentation and poor specificity, definitive diagnosis needs tissue biopsy and culture by laparoscopy., Case Report: We report the case of a 22-year-old female with a 2-month history of abdominal pain and distention. Symptomatic relief when supportive treatments were given, with the ultrasound and PET-CT suggested advanced bilateral ovarian cancer. After metagenomic next-generation sequencing (mNGS) detected C. trachomatis in ascitic fluid. Following anti-infective medication, clinical improvement was satisfactory and the patient was discharged., Conclusion: FHCS with distention was rare and challenging to diagnose. The mNGS would be a potent, non-invasive pathogen detection method with significant sensitivity and specificity., Competing Interests: Declaration of competing interest The authors have no conflicts of interest relevant to this article., (Copyright © 2024. Published by Elsevier B.V.)

Clinical manifestations of congenital syphilis (CS) include liver disease with/without impaired liver function, identified as syphilitic hepatitis. Hepatic involvement may be dramatic; therefore, early diagnosis is crucial to provide treatment and prevent fatal outcomes. A new resurgence of CS cases has been described in recent years worldwide. We reported our experience with a case series of infants hospitalized for liver disease with a final diagnosis of CS, highlighting the wide spectrum of liver involvement, the rapid progression in cases with late diagnosis, and the pitfalls of the management of this forgotten but reemerging disease. A retrospective analysis of CS patients with hepatic presentation in the period 2008-2023 was conducted. We collected five cases (three female) with a median age of 13.8 days (range 1-84 days). In three cases, mothers were not screened for syphilis during pregnancy, and in two cases, they were seronegative in the first trimester screening. None practiced specific therapy during pregnancy. Hepatic involvement was characterized by hepatosplenomegaly, in four cases associated with cholestatic jaundice and in three cases with liver failure. Rapid plasma reagin (RPR) and Treponema pallidum hemagglutination assay (TPHA) were positive in all cases in mothers and infants. CS presented with multiorgan involvement and was fatal in one case.Conclusions: It is important to consider CS in infants with cholestasis and acute liver failure, but also in sick infants with isolated hepatomegaly. Early recognition of infants with CS is critical to identify missed cases during pregnancy and to start early treatment., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: Giant cell hepatitis is an important diagnostic consideration in early childhood, especially for patients who present with jaundice. Different diseases may play a role in their etiology. In this study, we presented pediatric patients in our center diagnosed with giant cell hepatitis., Materials and Methods: Liver biopsies performed in our hospital between January 2010 and December 2023 were retrospectively evaluated, and biopsies with histological giant cell formation were included in the study. Demographic, clinical, and histopathological characteristics of the patients were obtained from the medical records., Results: Our study included 31 cases of giant cell hepatitis. Twenty-four (90.3%) of the patients were male, and the median age was 4 months (range, 1-148 mo). The most common clinical findings were jaundice (93.5%). Among the 31 patients, idiopathic giant cell hepatitis was observed in 13 cases (41.9%), and etiology was elucidated in 18 patients. The most common diagnoses in these patients were progressive familial intrahepatic cholestasis, biliary atresia, and autoimmune hepatitis (22.6%, 19.4%, and 9.7%, respectively). The most common accompanying histopathologic findings were canalicular cholestasis (87.1%), lobular cholestasis (54.8%), and pericellular fibrosis (35.5%). Liver transplant was required in 10 patients (32.3%). Nine patients (29%) died from various reasons. Although follow-up of 13 patients (41.9%) are ongoing, 9 patients (29%) are no longer being followed., Conclusions: Few studies in the pediatric age group on giant cell hepatitis have been conducted in the literature. Similar to our series, etiology could not be specified in most of the patients in these reports. Additional research is needed to improve our understanding of the disease process, uncover any other potential causes, and create specific treatment options.

Background: The COVID-19 pandemic significantly compromised screening, laboratory controls, clinical surveillance and treatment of chronic hepatitis patients and worsened their outcome, as evidenced by its significant correlation with advanced cirrhosis, liver decompensation and mortality. Results: This pandemic significantly impaired also the sector of liver transplantation, whose wards, operating rooms, outpatients' facilities, and healthcare personnel have been dedicated to patients with COVID-19. In addition, screening and treatment for HBV infection have been delayed or suspended in in most countries, with an increased risk of viral reactivation. Similar delay or suspension have also occurred for universal hepatitis B vaccination programs in many countries. Likewise, COVID-19 pandemic has made unreachable the goal of elimination of HCV infection as a worldwide public-health issue predicted for 2030 by the WHO. Conclusion: This review article demonstrates how COVID-19 pandemic is causing serious damage to the sector of liver disease, which has quickly lost the beneficial effects of years of study, research, and clinical and technological application, as well as considerable financial investments. [ABSTRACT FROM AUTHOR]

Introduction: Hepatitis infections are endemic in many countries. The serological hallmark for these infections is the presence of antibodies and antigens in the blood of the infected persons. These serological markers give an idea on the seropositivity of specific hepatitis. Objectives: This research was designed to investigate the seroprevalence of hepatitis A (HAV), B (HBV) and C (HCV) infections among patients attending health care facilities in two riverine communities in Akwa Ibom State, Nigeria. Methods: A cross sectional-descriptive study was conducted in two riverine communities, namely: Ikot Abasi and Oron, as well as one upland community, Uyo, as a control. Ethical approval and consents were obtained from the State Ministry of Health and volunteers. Three hundred (300) blood samples, 100 samples from each study area were collected and tested for the presence of HAV, HBV, and HCV antibodies and antigens using hepatitis rapid immunoassay and antibodies kits (Acon Diagnostics, USA), respectively. Structured questionnaires were used to obtain socio-demographic information from participants. Results: The prevalence rates of HAV, HBV, and HCV infections were: 14%, 10% and 6% in Ikot Abasi; 20%, 14% and 8% in Oron; while Uyo recorded 2%, 12% and 6%, respectively. The prevalence of HAV infection at the riverine communities was significantly higher than in the control (p=0.016). Children ≤ 10 years showed a higher prevalence of HAV. The prevalence of HBV and HCV infections in the riverine communities did not differ from the control (p=0.011). Prevalence based on socio- demographic parameters differed (p<0.05) in some study areas. Conclusion: Predisposing factors for the transmission of hepatitis A infection, such as indiscriminate sewage disposal, lack of awareness and sensitization campaign abound in riverine communities. These factors are not responsible for transmission of HBV and HCV infections in both the riverine and non-riverine communities. Therefore, proper hygiene, good sexual conduct, awareness and vaccination campaign are encouraged in the study areas. [ABSTRACT FROM AUTHOR]

Alcohol-related liver disease is a spectrum of disease in which continued, significant alcohol use can cause progression from fatty changes in the liver to inflammation, fibrosis, and eventually cirrhosis. The rates of alcohol consumption, alcohol use disorder, and alcohol-related liver disease have increased substantially during the past several years. However, the amount of alcohol consumption may not be the only risk factor for such progression of disease. Studies have found several other risk factors, including sex, race, and genetic predisposition, as possible culprits of worsening disease. As a result, clinicians must understand and implement screening tools for early diagnosis and remain up-to-date with the evolving nature of treatment options. This article reviews the diagnosis and treatment of alcohol use disorder as well as the pathophysiology, clinical presentation, and treatment of alcohol-related liver disease, including alcohol-associated hepatitis. [ABSTRACT FROM AUTHOR]

The article reports on the marketing authorization granted by the U.S. Food and Drug Administration (FDA) for Cepheid's Xpert HCV test and GeneXpert Xpress System, the first rapid test for hepatitis C vius intended for use in point-of-care settings. Topics include significance of the FDA's authorization, comments from FDA's Center for Devices and Radiological Health director Jeff Shuren, and risks correlated with the test.

Pembrolizumab is a monoclonal antibody programmed cell death 1 inhibitor that is an established treatment for melanoma and various lung cancers. Whilst an effective treatment option, it is known to have multiple immune related adverse events associated with its use, including neurological complications such as myasthenia gravis. Previous case reports on the treatment of Pembrolizumab induced myasthenia gravis have detailed the difficulty in managing the condition. There is increasing evidence that Rituximab, a monoclonal antibody directed at CD20 antigen B cells may be an effective treatment option for this condition. This case report outlines the successful treatment of a patient with Pembrolizumab induced myasthenia gravis who was managed with Rituximab. [ABSTRACT FROM AUTHOR]

Hepatitis A viral infection is a common illness across the globe, particularly among the pediatric population. In 30% of infected children below 6 years, it presents as symptomatic hepatitis. Epstein-Barr virus (EBV) infections are common in early childhood and cause infectious mononucleosis in young adolescents. Primary EBV infection presentation as isolated hepatitis without infectious mononucleosis (IM) syndrome is very rare. In tropical countries, co-infections are common. We report acute hepatitis due to dual infection of hepatitis A and EBV in an 8-year-old child. [ABSTRACT FROM AUTHOR]

The research aimed to develop a web-based application using the certainty factor. The use of this certainty factor method allowed processing the data based on the degree of confidence from the experts and the users. The users inputted their symptoms each with the level of confidence. The inference engine drew some conclusions based on the matching process between the input and the rules in the knowledge-based. For every matching pair, the system would calculate the certainty factor. The knowledge-based was developed through discussion with three specialist physicians and literature in some previous studies. The evaluation of the system involved three specialists for validation testing and 51 respondents for BlackBox testing. The final result is displayed in the form of a percentage for each hepatitis type, explanation of first aid for hepatitis, and referral hospital for hepatitis patients. The result shows that the error rate in the diagnosis process is under 36%. Most of the respondents think that the quality of the system is good overall.

Syphilitic hepatitis is a very rare presentation of syphilis infection, characterized by inflammation of the liver due to the invasion of hepatic tissue by the bacterium Treponema pallidum. This review article provides an in-depth analysis of the existing body of information pertaining to syphilitic hepatitis. The article primarily concentrates on key aspects such as the epidemiology, clinical manifestations, diagnostic methods, and therapeutic approaches associated with this condition. Despite its rarity, awareness of syphilitic hepatitis is vital for accurate diagnosis and appropriate intervention. The clinical presentations frequently exhibit similarities with many liver illnesses, hence presenting difficulties in making an accurate diagnosis. Common symptoms include fatigue, stomach pain, and jaundice. Diagnostic procedures encompass the use of serological assays, including rapid plasma reagin (RPR) and fluorescent treponemal antibody absorption (FTA-ABS), in conjunction with imaging modalities to evaluate hepatic engagement. The primary therapeutic approach is the prompt initiation of antibiotic therapy, with a particular emphasis on penicillin, to eradicate the causative bacterial infection and facilitate the restoration of liver function. Failure to swiftly manage this condition may result in substantial morbidity. In summary, syphilitic hepatitis is a very uncommon but medically relevant manifestation of syphilis infection. The significance of increased clinical suspicion, precise diagnostic techniques, and prompt antibiotic administration is emphasized in this review since these are crucial in reducing the potentially severe outcomes associated with this illness., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

SummaryUlcerative colitis (UC), a chronic inflammatory bowel disease, can cause extraintestinal manifestations (EIMs) in approximately 40% of individuals. This case report discusses the diagnostic procedure of a woman in her 20s who initially had non-specific symptoms. The patient underwent a thorough evaluation, which initially pointed towards tuberculosis (TB) due to necrotic lymphadenopathy and granulomatous hepatitis. However, no microbiological evidence of TB was found, and her symptoms worsened despite antitubercular therapy. The patient developed painful nodular-ulcerative skin lesions consistent with cutaneous polyarteritis nodosa (cPAN) on biopsy. Eventually, a definitive diagnosis of UC was made, revealing the true nature of her multisystemic manifestations. Cutaneous vasculitis, including leucocytoclastic vasculitis and cPAN, is a rare EIM of UC, with only five reported cases in the literature. This case report highlights the clinical implications of EIMs and contributes to the expanding knowledge of rare EIMs such as cPAN and granulomatous hepatitis., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

This is the case of a 25-year-old patient, with the notion of unprotected sexual relations with multiple partners consulted for cholestatic icterus with pruritus evolving for 2 months. The general examination found an intense mucocutaneous icterus. The examination of the lymph nodes revealed multiple lymph nodes. A thoracic-abdominal-pelvic scanner showed peri-portal edema and adenopathies above and below the diaphragm without suspicious lesions. Biologically, there was acute cytolysis with ASAT at 1612IU/L, ALAT at 1506IU/L, and icteric cholestasis, the acute viral serologies and other autoantibodies were all negative. Given the presence of adenopathy and sexual risk factors, a syphilis serology was requested and was positive: a TPHA at 2560UI/L, and a VDRL at 1/32 UI/L. A liver biopsy was performed, which showed the presence, on immunohistochemistry, of anti-treponemal-pallidum antibodies. After eliminating all etiologies of cytolytic hepatitis, we retained the diagnosis of syphilitic hepatitis. Therapeutically, we started a treatment based on ceftriaxone 2g/dl with spectacular biological improvement at H48 of the beginning of treatment., Competing Interests: The authors declare no competing interests., (Copyright: Sakina El Mamouni et al.)

Fowl adenoviruses (FAdVs) associated with inclusion body hepatitis (IBH) was identified in commercial broiler chickens in Palestine. Investigated birds showed primary clinical signs and lesions of IBH including growth retardation, congested and enlarged liver with necrosis, petechial hemorrhage and basophilic intra-nuclear inclusion bodies. The mortality rate was from 15.00%. The FAdV was detected and sequenced in the liver samples of infected chicken by polymerase chain reaction using hexon gene-specific primers. Phylogenetic analysis revealed that FAdVs belong to FAdV-D serotype 10, clustered within the European highly pathogenic isolates. The highest nucleotide sequence similarity was 99.48% with highly pathogenic FAdV-D serotype 10 detected from infected chicken in Poland (GenBank: LN907532.1) and FAdV-D from infected chicken in Sweden (GenBank: HE961828.1). The lowest similarity was 93.46% with Canadian FAdV-D (GenBank: EF685576.1). In conclusion, this is the first report describing the presence of IBH revealing that the causative virus is closely similar to the highly pathogenic FAdV-D serotype 10 of IBH in broiler chickens in Palestine. [ABSTRACT FROM AUTHOR]

Aim: Fatty liver is a common liver disease in the community. Mitochondrial dysfunction and oxidative process cause insulin resistance, causing fatty liver. Fatty liver diseases are higher in patients infected with chronic hepatitis B virus (HBV) than the normal population. We aimed to investigate the relationship between hepatosteatosis and biochemical and histopathological parameters in chronic HBV patients. Materials and Methods: Patients with follow-up between September/2017-November/2019 with chronic HBV diagnosis were included. Demographic and histopathological data of all patients were documented. Comorbid diseases, medications and previous operations were questioned. The presence of steatosis was determined by ultrasonography (USG) to all patients. Biochemical and histopathological data were compared with the presence of steatosis. Results: A total of 94 patients, 50(53.1%) women were included in the study. As a result of liver biopsy; while 20(21.2%) patients had no fibrosis (steage 0), 74(78.8%) patients had fibrosis (steage 1-3). In USG, 45(47.8%) patients were found to have hepatosteatosis and 49(52.2%) patients were not. In the comparison between the groups; there was no significant relationship between sex, age, liver function tests, HBV-DNA level, hepatic activity index and hepatosteatosis (p>0.05). A significant relation was found between the presence of fibrosis and hepatosteatosis (p=0.021). Conclusions: Chronic HBV is an inflammatory process that ends with cirrhosis and hepatocellular carcinoma, and in this process, fatty liver may increase disease and cause disease progression. In this context, it is important to prevent the development of steatosis in chronic HBV patients. However, this should be supported in prospective studies in larger populations. [ABSTRACT FROM AUTHOR]

How liver tolerance is disrupted in immune‐mediated liver injury is currently unclear. There is also insufficient information available regarding susceptibility, precipitation, escalation, and perpetuation of autoimmune hepatitis. To explore how dietary fiber influences hepatic damage, we applied the concanavalin A (ConA)‐induced acute immune‐mediated liver injury model in mice fed a diet supplemented with 6.8% inulin, a water‐soluble fermentable fiber. Twelve hours after ConA administration, inulin‐supplemented diet‐fed mice demonstrated significantly alleviated hepatic damage histologically and serologically, with down‐regulation of hepatic interferon‐γ and tumor necrosis factor and reduced myeloperoxidase (MPO)‐producing neutrophil infiltration. Preconditioning with an inulin‐supplemented diet for 2 weeks significantly reduced hepatic adenosine triphosphate (ATP) content; suramin, a purinergic P2 receptor antagonist, abolished the protective effect. Of note, the portal plasma derived from mice fed the inulin‐supplemented diet significantly alleviated ConA‐induced immune‐mediated liver injury. Mechanistically, increased portal short‐chain fatty acid (SCFA) levels, such as those of acetate and butyrate, by inulin supplementation leads to up‐regulation of hepatic γ‐type peroxisome proliferator‐activated receptor (Pparg) and uncoupling protein 2 (Ucp2), which uncouples mitochondrial ATP synthesis downstream of PPARγ. Pparg down‐regulating small interfering RNA cancelled the protective effect of inulin supplementation against MPO‐producing neutrophil infiltration and the subsequent immune‐mediated liver injury, suggesting that the SCFA–PPARγ–UCP2 axis plays a key role in the protective effect by inulin supplementation. Moreover, significant changes in the gut microbiota, including increased operational taxonomic units in genera Akkermansia and Allobaculum, also characterized the protective effect of the inulin‐supplemented diet. Conclusion: There is a possible unraveled etiopathophysiological link between the maintenance of liver tolerance and dietary fiber. The SCFA–PPARγ–UCP2 axis may provide therapeutic targets for immune‐mediated liver injury in the future. [ABSTRACT FROM AUTHOR]

Introduction. Two closely related groups of human herpesvirus 6 (HHV-6) are recognized, HHV-6A and HHV-6B. Although HHV-6 is considered a benign virus in immunocompetent patients, it can cause severe forms of the disease, such as severe hepatitis and meningoencephalitis. Case reports. We report the cases of two twin sisters with no prior medical history who presented in our hospital for fatigability, jaundice, acholic stools and hyperchromic urine. The clinical examination revealed jaundice and sensibility in the upper right abdominal quadrant, without hepatosplenomegaly. Laboratory tests revealed elevated liver transaminases, elevated cholestasis enzymes and hyperbilirubinemia. After excluding the usual causes of infectious hepatitis (including enteroviruses and Toxoplasma infection), autoimmune hepatitis and inborn errors of metabolism, we tested for HHV-6 antibodies, which were positive. We confirmed the diagnosis of HHV-6 associated hepatitis based on positive viremia, and the treatment with ursodeoxycholic acid and hepatoprotective medications was started. The children had an excellent evolution, with the resolution of symptoms in 10 days. Conclusions. HHV-6 is known for causing systemic illness in immunocompromised hosts, but some mild-to-moderate hepatitis cases can also be found in immunocompetent patients. [ABSTRACT FROM AUTHOR]

Autoimmune hepatitis (AIH) is an immune‐mediated chronic liver disease that affects all ages, including women of childbearing age. Optimal management during pregnancy is poorly defined. We aimed to explore the clinical and biochemical course of AIH in the antenatal and postpartum periods, and assess factors associated with premature birth and postpartum flares. Pregnant women with AIH reviewed in the autoimmune liver disease clinic at the Queen Elizabeth Hospital Birmingham between 2009 and 2020 were identified retrospectively, and clinical, biochemical, and immunological data 1 year before conception to 1 year postpartum were collected. Analysis was performed to identify trends in blood markers over the antenatal period, with an interrupted time series approach used to assess postpartum trends. Data were available for n = 27 pregnancies (n = 20 women), with median gestation of 38 weeks (30% premature) and most having type 1 AIH (78%) and delivering via caesarean section (63%). Levels of alanine transaminase, aspartate transaminase, and immunoglobulin G all declined significantly during gestation, followed by significant step‐change increases after delivery. Postpartum flare developed in 58% of pregnancies. AIH type 2 was associated with a higher rate of premature births (67% vs. 19%, P = 0.044), and a trend toward a higher rate of postpartum flare (100% vs. 48%, P = 0.053). Although not significant, medication nonadherence was associated with almost double the risk of prematurity (40% vs. 24%, P = 0.415) and postpartum flare (80% vs. 44%, P = 0.109). Conclusion: Biochemical and immunological remission of AIH occurs during pregnancy, although subsequent postpartum flare is common. Type 2 AIH is associated with a higher risk of premature birth and postpartum flare, although further research is required to validate and explain this finding. [ABSTRACT FROM AUTHOR]

Background: Kenya has a high burden of HIV, viral hepatitis, and tuberculosis. Screening is necessary for early diagnosis and treatment, which reduces morbidity and mortality across all three illnesses. We evaluated testing uptake for HIV, viral hepatitis, and tuberculosis in Kisumu, Kenya.Methods: Cross-sectional data from adults aged 18-35 years who enrolled in a prospective HIV incidence cohort study from February 2017 to May 2018 were analyzed. A questionnaire was administered to each participant at screening for study eligibility to collect behavioral characteristics and to assess prior testing practices. Among participants without a history of previously-diagnosed HIV, multivariable robust Poisson regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for factors potentially associated with HIV testing in the 12 months prior to enrollment. A hierarchical model was used to test for differential access to testing due to spatial location.Results: Of 671 participants, 52 (7.7%) were living with HIV, 308 (45.9%) were female, and the median age was 24 (interquartile range 21-28) years. Among 651 (97.0%) who had ever been tested for HIV, 400 (61.2%) reported HIV testing in the past 6 months, 129 (19.7%) in the past 6-12 months, and 125 (19.1%) more than one year prior to enrollment. Any prior testing for viral hepatitis was reported by 8 (1.2%) participants and for tuberculosis by 51 (7.6%). In unadjusted models, HIV testing in the past year was more common among females (PR 1.08 [95% CI 1.01, 1.17]) and participants with secondary education or higher (PR 1.10 [95% CI 1.02, 1.19]). In the multivariable model, only secondary education or higher was associated with recent HIV testing (adjusted PR 1.10 [95% CI 1.02, 1.20]). Hierarchical models showed no geographic differences in HIV testing across Kisumu subcounties.Conclusions: Prior HIV testing was common among study participants and most had been tested within the past year but testing for tuberculosis and viral hepatitis was far less common. HIV testing gaps exist for males and those with lower levels of education. HIV testing infrastructure could be leveraged to increase access to testing for other endemic infectious diseases. [ABSTRACT FROM AUTHOR]